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Department of the Treasury - Internal Revenue Servi ce
Form 668 ( Notice of Federal Tax Lien
(Rev. February 2 2004) 004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 869038012
As provided by section 6321, 6322, and 6323 of the Internal Revenue /a - 3 3,2
Code, we are giv?g a notice that taxes (including interest and penalties)
have been assess i against the following-named taxpayer. We have made
a demand for pa ent of this liability, but it remains unpaid. Therefore, :
there is a lien in favor of the United States on all property and rights to
property belongi g to this taxpayer for the amount of these taxes, and .z-
additional penalt s, interest, and costs that may accrue. -'
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Name of Taxpayer, ZI CHARD L CAMPBELL C
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Residence 10 ACCENT CIR
CAMP HILL, PA 17011-1021 ?a
IMPORTANT LEASE INFORMATION: For each assessment listed below,
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unless notice of th'lien is refilled by the date given in column (e), this notice shall,
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a/ S['?
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n the day following such date, operate as a certificate of release as defined
o f
t
°
n IRC 6325(a).
i )e/- 7 76
Period
I Date of Last Day for Unpaid Balance
Kind of Tax nding Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2006 XXX-XX-3292 06/06/2011 07/06/2021 68807.64
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 68807.64
This notice was prepared and signed at
the 18th day of may
DETROIT, MI
2012
, on this,
Signature ATitle
CS SBSE 22-00-0001
for P.A. BELTON (800) 829-3903
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X